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Vascular and Interventional Services
A CVAC is a tube that is inserted beneath your skin so there is a simple, pain-free way for doctors or nurses to draw your blood or give you medication or nutrients. When you have a CVAC, you are spared the irritation and discomfort of repeated needlesticks. More than 3.4 million CVACs are placed each year, and doctors increasingly recommend their use. There are several types of CVACs, including tunneled catheters (Hickman or Broviac), peripherally inserted central catheters (also called PICC lines or long lines), dialysis catheters, and implantable ports.
Read more about central vascular access procedures here.
Doctors often recommend CVACs for patients who regularly have:
- Chemotherapy treatments
- Infusions of antibiotics or other medications
- Nutritional supplements
Patients who have a clot in the veins of the lower extremities and cannot be anticoagulated may need a filter placed within the inferior vena cava to prevent a pulmonary embolus. It is a tiny cage-like device that is inserted in a blood vessel to catch clots and prevent them from reaching the heart or lungs. The filter can prevent a life threatening pulmonary embolus and can be safely placed by a radiologist using a neck or leg vein.
Read more about IVC filter placement here.
Embolization techniques employ delivery of clotting agents (coils, plastic particles, gel, foam, etc.) directly to an area that is bleeding or to block blood flow to a problem area, such as an aneurysm or a fibroid tumor in the uterus.
Embolizations performed by a trained internventional radiologist can prevent major open surgeries. Small catheters and wires are guided under X-ray to perform these minimally invasive procedures.
Read more about embolization procedures here.
In this technique, the interventional radiologist inserts a very small balloon attached to a thin catheter into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery. Sometimes, a small metal scaffold, called a stent, is inserted to keep the blood vessel open.
Read more about this procedure here.
Contrast is injected in a vein in order to detect an abnormality, such as a narrowing or blockage. The abnormality can sometimes be treated with balloon angioplasty or stenting.
Read more about venography here.
Thrombin is injected percutaneously into a pseudoaneurysm to cause thrombosis. This is most commonly performed on a pseudoaneurysm arising from the femoral arteries after arteriogram and is an efficient safe alternative to a surgical repair.
Devices or fragments can sometimes dislodge within the vascular system and may need to be removed. This is performed by a trained interventional radiologist employing minimally invasive techniques with small catheters, wires, and loop snare devices within the vascular system under X-ray guidance.
Read more about foreing body retrieval here.
When there is a blockage of the bile ducts from inflammation, gallstones, or cancer, a trained interventional radiologist can bypass the obstruction with small catheters and wires under X-ray guidance.
A plastic catheter is placed into the biliary tree to provide a temporary passageway for bile to drain from the liver to an external drainage bag.
Sometimes a stent or catheter can be advanced into the bowel to allow internal drainage.
This procedure is performed when the gallbladder is inflamed and surgery cannot be safely performed.
A small catheter is inserted through the skin surface on into the gallbladder under image guidance to allow infected bile to drain into an external collection bag.
Doctors often recommend placing a gastrostomy tube in the stomach for a variety of conditions in which a patient is unable to take sufficient food by mouth.
In the procedure, the feeding tube is inserted through a small nick in the skin and into the stomach under X-ray guidance.
Fluid within the abdominal and pelvis peritoneal cavity is removed using ultrasound guidance and a small catheter that is temporarily inserted.
This procedure is performed for diagnostic or therapeutic purposes.
This procedure is performed when the kidneys and ureters are blocked from stones or other other processes such as cancer or scarring. The patient is placed on their stomach and a small catheter is inserted into the skin and into the kidney under image guidance to help alleviate the obstruction.
Patients with blockage of the ureters may benifit from internal plastic stents which can be placed by an interventional radiologist under X-ray guidance.
Male patients with symptomatic enlarged testicular or scrotal veins, called varicoceles, may benefit from minimally invasive catheter directed embolization.
Read more about varicoceles and testicular vein embolization here.
Needle biopsy is a procedure performed by radiologists to identify the cause of a lump or mass, or other abnormal condition in the body. It has replaced the need for many open surgical biopsy procedures.
During the procedure, the doctor inserts a small needle, guided by X-ray, CT, or Ultrasound into the abnormal area.
A sample of tissue is removed and given to a pathologist who looks at it under a microscope to determine what the abnormality is -- for example, cancer, a noncancerous tumor, infection, or scar.
Read more about biopsies here.
Patients who have fluid building up around their lung can benefit from drainage of the fluid for symptom relief and for diagnostic purposes.
A radiologist can use Ultrasound to guide a needle where the fluid is to safely drain.
Patients who have recurring pleural fluid may be a candidate for a long term chest tube that is placed under the skin (tunneled) and then into the chest for drainage purposes.
An embolization procedure of uterine arteries used by interventional radiologists for benign conditions such as uterine fibroids. It is also performed to stop life-threatening postpartum bleeding, potentially preventing hysterectomy.
The procedure uses X-ray to guide small catheters to the arteries to cut off the blood supply to the fibroid or the areas of bleeding.
Read more about uterine fibroid embolization here.
This procedure is performed under X-ray on patients who are being treated for infertility and may have occluded fallopian tubes. A small catheter is inserted into the uterus and fallopian tubes.
Read more about hysterosalpingogram here.
Female patients who have symptomatic painful enlarged pelvic and ovarian veins may benefit from X-ray guided minimally invasive catheter directed embolization.
Read more about ovarian vein embolization here.
Patients with osteoporosis, due to age, chemotherapy or other factors, are at increased risk for painful vertebral compression fractures. As an alternative to major surgery, these fractures can be treated by a radiologist using X-ray to guide needles in the spine fractured area, create a cavity with small balloons, and place a fast setting polymer to "internally cast" the fracture.
Read more about Kyphoplasty here.
Patients who have infected fluid collections in their body may be a candidate for radiology image guided placement of a small catheter into the fluid to drain the fluid out. This can help avoid a major surgical procedure.
Steroid injections are minimally invasive X-ray guided procedures performed by a radiologist to alleviate pain, most often in the spine and joints. Anti-inflammatory agents are injected directly into the targeted area. This can be performed in patients who suffer pain caused by bulging disks, stenosis of the spine, or post operative surgery syndromes. Additionally steroid injections can be used to alleviage degenerative joint pain such as in hips or knees.
Read more about this procedure here.
Myelograms are minimally invasive diagnostic procedures in which contrast is injected into the spinal canal under X-ray guidance. X-rays and CT images are then obtained which are interpreted by a radiologist to evaluate the spinal column, spinal cord, any major areas of disk bulging, and nerve roots. Patients undergoing workup for back pain may benefit from the additional information from this procedure.
Read more about myelograms here.
Facet joint and nerve root blocks are minimally invasive X-ray guided procedures performed by a radiologist to alleviate pain in patients by selectively injecting anti-inflammatory agents around the spinal facet joints or around the adjacent spinal nerves.
Read more about this procedure here.
A Discogram is a minimally invasive test to help doctors determine the cause of back pain. Under X-ray guidance a small needle is placed in the intervertebral disc. Contrast is injected to evaluate the disc and to help quantitate and localize the back pain.
Some patients may also be candidates for a procedure called Disc Nucleoplasty where a portion of the inner part of the disk is removed by a small needle following which a thermal ablation is performed to help alleviate symptoms from bulging disks.
Read more about discography here.
Cardiac CTA is a specialized CT scan that is performed to assess a patient's coronary arteries for atherosclerotic plaque, or hardening and plaque build up in the arteries surrounding the heart. For some patients this test can be performed as a diagnostic noninvasive alternative minimally invasive heart catheterization procedure.
Read more about cardiac CTA here.
Peripheral Arterial Disease (PAD)-clogged or narrowed arteries in the legs-is a red flag that the same process may be going on elsewhere in the body because PAD is associated with other life-threatening vascular diseases.
Through early detection, interventional radiologists can save women from future stroke, heart attack, and early death. To combat this major public health issue, the Society of Interventional Radiology recommends greater screening efforts by the medical community through the use of the Ankle Brachial Index (ABI) test as well as noninvasive tests such as ultrasound.
Further minimally invasive procedures such as balloon angioplasty and stenting can be performed by an interventional radiologist to help open the arteries, should the test show any blockages.
Patients with tumors of the liver, kidney, or bone may be eligible for Image Guided Tumor Ablation. This can be performed by a trained interventional radiologist using imaging to place a needle into the tumor to treat it locally. Also some tumors can be treated through the arteries with small catheters and with special chemotherapy or embolic agents to block up the blood vessels feeding the tumors.
Deep vein thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the leg, known as Post-Thrombotic Syndrome, or a life-threating pulomnary embolism. The deep veins that lie near the center of the leg are surrounded by powerful muscles that contract and force deoxygenated blood back to the lungs and heart. One-way valves prevent the back-flow of blood between the contractions. (Blood is squeezed up the leg against gravity and the valves prevent it from flowing back to our feet.) When the circulation of the blood slows down due to illness, injury or inactivity, blood can accumulate or "pool," which provides an ideal setting for clot formation.
Some patients with blood clots may be candidates for interventional radiology directed placement of a catheter and use of "clot busters."
Patients that need long term IV access for medicines such as chemotherapy can benefit from the placement of an implantable port. A radiologist can use ultrasound and X-ray to safely place the device under the skin and into the vascular system.
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